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Concussion

Topic Overview

What is a concussion?

A
concussion is a type of traumatic brain injury that is caused by a blow to the head or body, a fall, or another injury that jars or shakes the brain inside the skull. Although there may be cuts or bruises on the head or face, there may be no other visible signs of a brain injury.

You don't have to pass out (lose consciousness) to have a concussion. Some people will have obvious
symptoms of a concussion, such as passing out or forgetting what happened right before the injury. But other people won't. With rest, most people fully recover from a concussion. Some people recover within a few hours. Other people take a few weeks to recover.

It's important to know that after a concussion the brain is more sensitive to damage. So while you are recovering, be sure to avoid activities that might injure you again.

In rare cases, concussions cause
more serious problems. Repeated concussions or a severe concussion may lead to long-lasting problems with movement, learning, or speaking.
Because of the small chance of serious problems, it is important to
contact a doctor if you or someone you know has symptoms of a concussion.

What causes a concussion?

Your brain is a soft organ that is surrounded by spinal fluid and
protected by your hard skull. Normally, the fluid around your brain acts like a
cushion that keeps your brain from banging into your skull. But if your head or
your body is hit hard, your brain can crash into your
skull and be injured.

There are many ways
to get a concussion. Some common ways include fights, falls, playground
injuries, car crashes, and bike accidents. Concussions can also happen while
participating in any sport or activity such as football, boxing, hockey,
soccer, skiing, or snowboarding.

What are the symptoms?

It is not always easy to know if someone has a
concussion. You don't have to pass out (lose consciousness) to have a concussion.

Symptoms
of a concussion range from mild to severe and can last for hours, days, weeks,
or even months. If you notice any symptoms of a concussion, contact your
doctor.

Symptoms of a concussion fit into four main categories:

Thinking and remembering

Not thinking clearly

Feeling slowed down

Not being able to concentrate

Not being able to remember new information

Physical

Nausea and vomiting

Headache

Fuzzy or blurry vision

Dizziness

Sensitivity to light or noise

Balance problems

Feeling tired or having no energy

Emotional and mood

Easily upset or angered

Sad

Nervous or anxious

More emotional

Sleep

Sleeping more than usual

Sleeping less than usual

Having a hard time falling asleep

Young children can have the same symptoms of a concussion as older children and adults. But sometimes it can be hard to tell if a small child has a
concussion. Young children may also have symptoms like:

Crying more than usual.

Headache that does not go away.

Changes in the way they play or act.

Changes in the way they nurse, eat, or sleep.

Being upset easily or having more temper tantrums.

A sad mood.

Lack of interest in their usual activities or favorite toys.

Loss of new skills, such as toilet training.

Loss of balance and trouble walking.

Not being able to pay attention.

Concussions in older adults can also be dangerous. This is because concussions in older adults are often missed. If you are caring for an older adult who has had a fall, check him or her for symptoms of a concussion. Signs of a serious problem include a headache that gets worse or increasing confusion or both. See a doctor right away if you notice these signs. If you are caring for an older adult who takes blood thinners—warfarin (Coumadin) is an example—and who has had a fall, take him or her to a doctor right away, even if you don't see any symptoms of a concussion.

Sometimes after a concussion you may feel as if you are not functioning as well as you did before the injury. This is called
postconcussive syndrome. New symptoms may develop, or you may continue to be bothered by symptoms from the injury, such as:

Changes in your ability to think, concentrate,
or remember.

Headaches or blurry vision.

Changes in
your sleep patterns, such as not being able to sleep or sleeping all the time.

Changes in your personality such as becoming angry or anxious for
no clear reason.

Lack of interest in your usual activities.

Changes in your sex drive.

Dizziness,
lightheadedness, or unsteadiness that makes standing or walking
difficult.

If you have symptoms of
postconcussive syndrome, call your doctor.

How is a concussion diagnosed?

Any person who may have had a concussion needs to see a doctor. If a doctor thinks that you have a concussion,
he or she will ask questions about the injury. Your doctor may ask you questions that test your ability to pay attention and your learning and memory. Your doctor may also try to find out how quickly you can solve problems. He or she may also show you objects and then hide them and ask you to recall what they are. Then the doctor will check your strength, balance, coordination,
reflexes, and sensation.

Neuropsychological tests have become more widely used after a concussion. These tests are only one of many ways that your doctor can find out how well you are thinking and remembering after a concussion. These tests can also show if you have any changes in emotions or mood after a concussion.

Sometimes a doctor will order imaging tests such as a
CT scan or an
MRI to make sure your brain is not bruised or
bleeding.

How is it treated?

Right away

After being seen by a doctor, some people have to stay in the
hospital to be watched. Others can go home safely. People who go home still need to be watched closely for warning signs or changes in behavior.

Call 911 or seek emergency care right away if you are watching a person after a concussion and the person has:

A headache that gets worse or does not go away.

Weakness, numbness, or decreased coordination.

Repeated vomiting or nausea.

Slurred speech.

Extreme drowsiness or you cannot wake them.

One pupil that is larger than the other.

Convulsions or seizures.

A problem recognizing people or places.

Increasing confusion, restlessness, or agitation.

Loss of consciousness.

Warning signs in children are the same as those listed above for adults. Take your child to the emergency department if he or she has any of the warnings signs listed above or:

Will not stop crying.

Will not nurse or eat.

In the days or weeks after

Some people feel normal again in a few
hours. Others have symptoms for weeks or months. It is very important to
allow yourself time to get better and to slowly return to your regular
activities. If your symptoms come back when you are doing an activity, stop and rest for a day. This is a sign that you are pushing yourself too hard. It is also important to call your doctor if you are not improving
as expected or if you think that you are getting worse instead of
better.

Rest is the best way to recover from a concussion. You need to rest your body and your brain. Here are some tips to help you get better:

Get plenty of sleep at night, and take it easy during the day.

Avoid alcohol and illegal drugs.

Do not take any other medicines unless your doctor says it is okay.

Avoid activities that are physically or mentally demanding (including housework, exercise, schoolwork, video games, text messaging, or using the computer). You may need to change your school or work schedule while you recover.

Ask your doctor when it's okay for you to drive a car, ride a bike, or operate machinery.

Use ice or a cold pack on any swelling for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin.

Use pain medicine as directed. Your doctor may give you a prescription for pain medicine or recommend you use a pain
medicine that you can buy without a prescription, such as acetaminophen (for
example, Tylenol).

Concussion and sports

A person who might
have a concussion needs to immediately stop any kind of activity or sport.
Being active again too soon increases
the person's risk of having a more serious brain injury. Be sure to see a doctor before returning to play.

How can you prevent a concussion?

Reduce your chances of getting a
concussion:

Wear a seat belt every time you drive or ride in a car or other motor vehicle.

Never drive when you are under the influence of drugs or alcohol.

Wear a helmet and safety equipment when you:

Play sports, such as baseball, hockey, and football.

Drive or ride on a motorcycle, scooter, snowmobile, or ATV.

Do other activities where you could injure yourself, such as biking, skateboarding, skiing, or riding a horse.

References

Other Works Consulted

American College of Emergency Physicians (ACEP) and Centers for Disease Control and Prevention (CDC) (2008). Clinical policy: Neuroimaging and decisionmaking in adult mild traumatic brain injury in the acute setting. Annals of Emergency Medicine, 52(6): 714–748.

American College of Sports Medicine (2006). Concussion (mild traumatic brain injury) and the team physician: A consensus statement. Medicine and Science in Sports and Exercise, 39(2): 395–399.

Giza CC, et al. (2013). Summary of evidence-based guideline update: Evaluation and management of concussion in sports: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology, 80(24): 2250–2257. Also available online: http://www.neurology.org/content/80/24/2250.full.

McCrory P, et al. (2013). Consensus statement on concussion in sport: The 4th International Conference on Concussion in Sport held in Zurich, November 2012. British Journal of Sports Medicine, 47(5): 250–258. Also available online: http://bjsm.bmj.com/content/47/5/250.full.

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